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Wisconsin rates for HCPCS 0117U

Pain management, analysis of 11 endogenous analytes (methylmalonic acid, xanthurenic acid, homocysteine, pyroglutamic acid, vanilmandelate, 5-hydroxyindoleacetic acid, hydroxymethylglutarate, ethylmalonate, 3-hydroxypropyl mercapturic acid (3-HPMA), quinolinic acid, kynurenic acid), LC-MS/MS, urine, algorithm reported as a pain-index score with likelihood of atypical biochemical function associated with pain

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $2,290.87 / $2,290.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $691.83 / $1,000.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $851.14 / $2,454.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $2,691.53 / $4,265.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,258.93 / $2,630.27
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $2,884.03 / $4,897.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $794.33 / $3,981.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $501.19 / $1,513.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $54.95 / $2,344.23
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,949.84 / $2,754.23
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $1,698.24 / $3,981.07
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $1,778.28 / $1,778.28
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,454.71 / $4,570.88 / $6,456.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $676.08 / $1,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $501.19 / $1,621.81